First Choice Health Insurance Coverage for Drug Rehab

First Choice Health is a provider owned organization that helps self funded employers provide health insurance to their employees. The company was founded in 1985 and is headquartered in Seattle, Washington.

Today they serve employers in eight states ranging from Alaska to Washington state to South Dakota. They offer a preferred provider (PPO) network and health plan administration as well as an employee assistance program and behavioral health services.

First Choice Health also gives back to their communities by partnering with Meals on Wheels and No Kid Hungry along with The Plate Fund and YWCA of Seattle.

Does First Choice Health Cover Addiction Rehab?

Self funded employer plans are not required to offer coverage for addiction or mental health, but many of them will. One of the key services First Choice Health provides to interested employers is access to behavioral health programs and resources.

All insurance plans focus on covering medically necessary care so you’ll want to work closely with your doctor to create a treatment plan. This treatment plan will help you know what kind of care to look for and provide proof of medical need.

However every self funded employer plan is different so be sure to talk to the benefits specialist at your company to get the full details of your insurance before you commit to treatment.

What Are First Choice Health Plans?

First Choice doesn’t offer insurance plans directly — they help self funded employers offer insurance to employees by offering access to high quality medical networks and other services.

First Choice Health has a PPO network that has over 120,000 providers that represent all medical specialties. The network extends through 11 states: Alaska, Washington, Oregon, Idaho, Montana, Wyoming, Colorado, Utah, Nebraska, and both Dakotas. The company helps employers with cost and medical management.

They also have health plan administration services to help employers manage their health plan and effectively offer insurance to employees. They can offer third party claims administration and cost containment along with data analysis.

Finally there are some specialty services available from First Choice Health. These include a clinically integrated network that can add support that traditional care team can’t. This can be helpful in complex healthcare situations and provides coordination between multiple facilities.

First Choice Health also connects employers to behavioral health services. This includes addiction treatment and mental healthcare. They provide a directory of in network providers to encourage members to stay in the network and they also have a behavioral health program with case managers for specific diagnoses so members have someone to guide them through the process of getting high quality care.

What Inpatient Addiction Treatment Does First Choice Cover?

While self funded plans are not required to cover addiction treatment under the Affordable Care Act many still will.

Insurance coverage is typically focused on medically necessary care which is why it’s so important to have a treatment plan with your doctor. If you need help in a residential facility your provider may rely on the American Society of Addiction Medicine (ASAM) assessment to determine if you meet certain criteria.

Once your doctor has assessed you you can discuss the possibility of medical detox and inpatient care — it may be safer for you to detox while under the care of medical professionals. Inpatient addiction care — with or without medical detox — is an intensive program that allows you to focus fully on your recovery.

What Outpatient Rehab Does First Choice Cover?

Outpatient treatment looks different for everyone. It is ideal for those with family or work obligations because you are at home outside of treatment sessions. Treatment consists of education and individual counseling along with group therapy. You’ll also have monitoring and help with relapse prevention.

A partial hospitalization program (PHP) is a day outpatient treatment. You spend your day in an intensive structured recovery program but you go home at night.

An intensive outpatient program (IOP) is another option and is ideal for those who need support after completing an inpatient program. It provides therapeutic processes for those who need support but you’re able to work the treatment around your work or school obligations.

Remember that self funded plans vary widely in requirements and limits as well as coverage so it’s always a good idea to check with your benefits specialist before committing to a treatment program.

Does First Choice Cover Methadone & Suboxone (MAT)?

If medically assisted treatment (MAT) is covered by your insurance plan it’s a valuable tool in the arsenal against addiction.

Medications like suboxone and methadone suppress cravings and block the high many get from using drugs and alcohol. These medications work well on a long term basis to manage cravings and help patients stay stable during treatment. They’re highly successful at preventing relapse.

Does First Choice Cover Other Mental Healthcare?

While self funded plans are not required to cover mental healthcare, many do. You must review your policy closely before starting any type of health care.

Mental health treatment generally includes counseling and crisis support for concerns such as depression and anxiety as well as PTSD and other diagnoses.

Addiction often goes hand in hand with mental illnesses which is known as co occurring disorders. It’s a vicious cycle as these conditions can move people toward addiction to cope and then addiction can make the conditions worse.

Treating mental illness and addiction at the same time is the most successful way to avoid relapse because these conditions feed into each other and you can’t successfully address one without the other.

Does Addiction Treatment Need to Be In Network?

First Choice Health offers out of network coverage as a PPO network. However, if you choose to go out of network for care, it’s important to remember that your copayments and deductibles will be significantly higher.

If possible, stay in network for your treatment to maximize your insurance coverage. Review your plan carefully and understand the costs before you choose an out of network provider.

What to Do if First Choice Won’t Cover the Cost of Rehab

Most self-funded plans cover some type of addiction treatment but if yours doesn’t — or doesn’t cover as much as you need — it’s still important to get the care you need.

Some treatment centers have a sliding fee scale based on income, and others offer payment plans or scholarships.

If you have savings or family help rely on that to help you get into a treatment program. There are also low cost and free rehabs that allow you to work rather than pay. One example of this is the Salvation Army.

Remember that no matter what your insurance coverage says you can’t put a price on your life.

How to Verify Coverage With First Choice

If you have questions about your coverage contact your benefits manager at your employer. If you have a customer service number you can use that as well. First Choice may provide benefit advice and help determine what treatment style you need and where you can get it based on your insurance plan.

You don’t want to ask a treatment center to verify your coverage because self funded plans are one of a kind and the center won’t have the most accurate information. Instead, talk to your benefits specialist or First Choice directly.